Ophtag 2019 Pallas - Kantonsspital St. GallenMicrosoft PowerPoint - Pallas_uveitis_ophtha2019.pptx...
Transcript of Ophtag 2019 Pallas - Kantonsspital St. GallenMicrosoft PowerPoint - Pallas_uveitis_ophtha2019.pptx...
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Ophtag 2019 Pallas
Eine bedrohliche Panuveitis
Ophtag 20.06.2019
Pallas
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Ophtag 2019 Pallas
Anamnese
· Patient männlich, 63J
· Plötzlicher Visusverlust links
· Schmerzen und Schwellung
· Links: Visus LP, RAPD, Tensio 26
· VKZ++, Präzipitate
· Rechts: regelrechter Befund, Visus 0.6
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Ophtag 2019 Pallas
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Ophtag 2019 Pallas
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Ophtag 2019 Pallas
Bedrohliche Panuveitis: DD
· CMV
· ARN/PORN
· Treponema
· Behcet
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Ophtag 2019 Pallas
Abklärungen
· Erhöhte Leberwerte
· Leichte Anämie
· HSV, VZV IgG positiv
· Restliche Serologien negativ
· BSR, CRP normal
· HLA B5 positiv
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Ophtag 2019 Pallas
Verlauf
· Zovirax i.v. hochdosiert
· Aspirin cardio
· Vitrektomie: VZV intravitreal
· CMV negativ
· Valtrex p.o.
· Patient erscheint nicht zur KO
· Aufgebot per Einschreiben
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Ophtag 2019 Pallas
· Notfall Konsultation 3W später
· Therapie abgesetzt
· Visusabfall rechts auf 0.1! Tensio 32 mmHg, VKZ +++
· Visus links nulla lux
Verlauf
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Ophtag 2019 Pallas
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Ophtag 2019 Pallas
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Ophtag 2019 Pallas
Verlauf
· 1W später unter Therapie
· Visus rechts 0.4
· Tensio regelrecht
· VK reizfrei
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Ophtag 2019 Pallas
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Ophtag 2019 Pallas
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Ophtag 2019 Pallas
Akute Retina Nekrose ARN:
Klinik
· Oft Schmerzhaft
· 20-60LJ
· Large KP`s
· Hoher Augendruck
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Ophtag 2019 Pallas
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Ophtag 2019 Pallas
Akute Retina Nekrose ARN:
Diagnostik
· Primär klinische Diagnose
· Serologie nur bedingt hilfreich
· PCR Glaskörper Sensitivität von 90%, Spezifität 100%
· VZV 50%, HSV-2 30%, HSV-1 15%, CMV 5%
· Suche Immuninsuffizienz
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Ophtag 2019 Pallas
Akute Retina Nekrose: Verlauf
· Rasche zentripetale Progression
· Konfluierend 360°
· Sek. Atrophie, NH Riss
· Schlechte Visusprognose (65% < 20/200)
· 1/3 geht aufs zweite Auge meist innerhalb Wochen
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Ophtag 2019 Pallas
Akute Retina Nekrose ARN: Therapie
· Therapie vor Diagnosesicherung
· Wahrscheinlichkeit des Befalls des 2. Auges von 70% auf 13% gesenkt!
· Kortikosteroide: kontrovers
� Therapie der Vitritis
� 24-48h nach antiviraler Therapie
· Lasertherapie? Prophylaktische Vitrektomie?
· Aspirin empfohlen